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Opinion: Aside from the abortion question, Ms Y highlights serious flaws in Irish maternity care

Remove abortion from the picture and we are still left with the highly troubling instance of a young, vulnerable women left traumatised by her encounter with the health service.

Deirdre Duffy

THE RESPONSE OF the Minister for Health and the tone of the HSE’s statement on the questionable treatment received by Ms Y attempt to frame this case as wholly about abortion and the application of the legislation governing the right to life of the unborn.

But abortion is only one part of this picture and in many ways not the main issue. The main issue in this case is care – what kind of care is available to pregnant women? Is that care of high quality? Does it meet with the care commitments of the European Charter for Patients’ Rights, the Health Information and Quality Authority’s National Standards for Safer Better Healthcare and World Health Organisation recommendations on maternity care? Who was privy to the design of the care treatment plan and was it discussed with the patient or imposed on her? Was she fully informed and did she understand the dimensions of the treatment options fully? And, after the fact, can we honestly view her (and her baby) as having been adequately cared for?

What do we know for certain? 

Ms Y’s case is a microcosm of the myriad of problems within debates around maternity care past and present. Remove abortion from the case and we are still left with the highly troubling instance of a young, vulnerable women left traumatised by her encounter with the health service. Both the Minister and the HSE have demanded that we reserve judgement until all the facts are made clear – that we remain “non-ideological” (to use the Minister’s phrasing) in our assessment of the case. But if we do ignore the personal accounts of Ms Y and those close to her, treat the interactions between healthcare professionals and Ms Y as problems in delivery and communication rather than systemic problems in the maternity care system, and focus solely on the facts then we only know two things for certain:

  1. Maternity services tried, as far as practicable, to keep both Ms Y and her baby alive
  2. A pregnant young woman was referred to maternity services and she and her baby emerged alive

Taken in context, we also know that this is the only concern of maternity services in Ireland. Constitutionally, medical professionals are obliged to preserve life “as far as practicable” but there is no obligation on doctors to demonstrate that they have factored in the future effects of pregnancy and childbirth on either the mother or the foetus. Their assessments on risk to life take place within the boundaries of gestation. They protect life DURING pregnancy. The patients are pregnant women and the unborn, not women and children.

Considering post-partum mental or physical health

The overwhelming focus on preservation of life is a consistent theme in both inquiries into care quality in maternity services in Ireland and legislation relating to maternity care. The report following the death of Savita Halappanavar explored whether the accepted clinical practices for preserving, insofar as practicable, the life of the unborn and of the mother had been followed.

The review of the practice of symphysiotomy is being couched in the language of ‘necessity’ – was the procedure necessary in order to keep women alive? There is specific guidance on the protection of life during pregnancy but none on ensuring that the health outcomes of pregnancy for women and children are the best they can be. Under the current system there was, and is, no obligation for health professionals (or their institutional and governmental representatives) to examine the effect Ms Y’s contact with maternity services has had on her post-partum mental or physical health.

At this juncture what we need to ask ourselves is not whether we think abortion is right or fair or legitimate. What we need to ask ourselves is whether we are content with a healthcare system which is obliged to keep you alive but not well. Are we satisfied to assess the quality of maternity care solely in terms of whether women and children are alive at the end? Is this going to be Ireland’s health legacy?

Are pregnant women being adequately cared for?

At the very least, to sit back and accept Ms Y’s experience as either necessary or indicative of best practice shows how unwilling we are to learn from historic scandals in maternity care. The Lourdes revelations, the accounts of symphysiotomy survivors, and the recent cases of Dhara Kivlehan and Sally Rowlette who died shortly after receiving emergency caesarean sections at Sligo General Hospital should, by rights, make a comprehensive review of the dynamics and quality of maternity care in Ireland an immediate and absolute necessary. And yet despite the obvious questions regarding what happens in maternity wards, the HSE and Minister for Health are seemingly happy to reduce Ms Y’s experience to a question of keeping pregnant women and the unborn alive for the duration of pregnancy – not a question of whether pregnant women are being adequately cared for.

The image of women entering maternity wards healthy and excited and leaving physically debilitated and mentally traumatised haunts the Irish maternity care system. Ms Y is only the most recent example of inadequacies in maternity care. Unless we begin to question how well women are being cared for within the confines of maternity wards the emergence of future scandals and continuance of care inadequacies remains a distinct possibility.

Dr Deirdre Duffy is a Lecturer in Social Science and a specialist in social and public policy research and evaluation based at Edge Hill University. 

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Deirdre Duffy

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